Monday, April 19, 2010

I was informed by certified mail last week that I've been approved for my state's substance abuse monitoring program, being able to look up ALL my patients' controlled substance scripts from all pharmacies and other doctors.

I activated my incredible new all-seeing powers this morning. And within an hour had fired 3 patients that we were suspicious of.

Mary and Annie are making up wish lists of people for me to check. It's like Christmas, in April.

now get ready for "whatchyoumean? i aint see no other doctor! that aint me man this is bulllshit. i dont abuse drugs i aint like that. im in pain. this is some serious shit man" then its your turn to say yeah it is some serious shit man now buhbye bye bye

C'mon, man, this is totally unfair. I'm sick. I have headaches. I NEED those MRIs. I don't know what that stupid government computer tells you, but if you don't send me to the MRI clinic, I'm not gonna get my MRIs, and then I'll die from my brain tumor and it'll be your fault and I'll report you to the state neurology council or whatever you call it. Yeah? Who are you gonna believe? Me or the lying government? Okay, okay, so there was that one time I went to that other neurologist for an MRI, but it was a special case. You were out of town or something. Yeah, okay, there was that other time too, but it was cause my grandmother had just died and I called and I'm pretty sure I left a message but that bitch you answers your phones never got back to me so I had no choice. All right, she's not a bitch. I'm sorry. I didn't mean to call her a bitch. Really. Can we just move on and talk about what's important? How about if you just let me go get an MRI? Just one more MRI and I'll never ask for anything else as long as I live. Okay? It's not like I'm asking for Gad or anything. But if I could have some Gad, that would be a lot better. Look, I understand, you've got your own problems. Maybe there's something I can do for you, Dr. MRI?

As someone who has used MSIR off and on [mostly OFF!] over the past few years for nasty problems, I applaud this. It's horrible being treated as a seeker when you're in terrible pain and very ill. It's happened to me so very rarely [once after I'd been admitted into the hospital -- for pain! -- by a nurse] but it's terrible to realize that people think you're abusing a medication you rarely take.

Being able to track who is abusing the system, that is there to HELP the rest of us, makes me hope that those of us who really need the help will have an even less chance of being treated like a seeker.

That seems so strange to me as even in the state that I live in (Texas) the police can access your narcotic prescription usage if you have a driver's license, so I have always assumed that any doc could do the same.No warrant or probable cause needed, as a very, very liberal democrat living in a sometimes backwards state this seems like an abuse or power for the local sherif to be able to troll through the medical records of their friends and neighbors. But doctors being able to do so for their patients seems prudent snd just good medical care if they have a concern about abuse of drugs and need for intervention.

i have mixed feelings about this. as "just a person", i think its a good thing, that it helps people who are abusing drugs to not fall through the cracks, and to hopefully get help.

as a person who *does* have chronic pain, i hate what those sort of laws do. oh, not that its stopping the drug seekers from abusing the system, but that the OMG YOU CANT HAVE THAT ITS HABIT FORMING frothing-at-the-mouth people are calling the shots because it enables doctor's offices to deny that they can write any sort of pain meds at all. like my gyno, when i was there hunched over in pain, tears running down my face, telling me "this office is not allowed to write pain meds."

or my endocrinologist, who shoves me off on my gp, who says "you're still walking around, so you dont need them." meanwhile, he's rolling around his office on a scooter.

oh and lets not forget the ever-so-gracious neurologist who dismissed me with "so you have migraines, i can see that. i just dont need to see you" without offering any ADVICE even on how to help the migraines. no, i'm not labeling *all* neuros as bad, just that one was hugely unhelpful.

some days are better than others. other times its months of mondays in a row. its been about 6 years of mondays so far. *shrugs*

Do you know what safeguards there are to make sure you have the right person? For instance, I live in a small town but there is one other person who has the same name I do. Search by name&city and it could be either one of us. If you use the full address, she uses her house number and I use a PO box, so people think think it's one person and they've found both addresses. Add in the birthday and that could help, except that her birthday is three days after mine and people sometimes assume that there was a typo. And when we had the same auto insurance company, I spent months trying to convince them that I hadn't been in a car wreck because they couldn't keep the two of us straight. I really hope that there are safeguards to make sure you have the right person!

My state does not have this program. It is harder to figure out who is gaming the system and who is legit. I have to use my superhuman powers to ferrit out the abusers. The non-abusers get hurt in the process. This really needs to be a national program. We are very close to a few other states and people could easily cross state lines for this.

It was only a matter of time until it was revealed that this was all about the presentation of the package. ;)

I practice in Emergency Medicine and have recently gained access to our state's controlled substance database. It is a gamechanger. I have had shady people who I would have considered highly probable drug seekers who really did just have chronic pain and always get their meds from the same PCP at the same time each month, and I have had people who seemed relatively legit but I searched anyway and found that they were getting RIDICULOUS amounts of narcotics and benzos from lots of different docs in lots of different towns. I usually print it off and show it to them, explaining that if they want more narcotics they'll need to speak with their PCP as I do not feel comfortable giving them anything more. They rarely argue (except for the "my brother fills those scripts in my name!" patients). It's a great tool.

Love it!! I usually tell my technicians to watch out because super pharmacist is here today and I pretend to fly with my invisible cape. Perhaps I should invest in a real one. All health care workers need super human strength and capes of course :)

Moose - To be honest, the majority of people we don't actually think are drug seekers, but are required to ask certain questions to ensure that you are getting the most appropriate treatment, or are required by law to ask. I'll use the example of pseudoephedrine, since I work in retail pharmacy. To sell a box of cold and flu, I need to assess the symptoms, how long they've been present, any other medications the patient may be taking, if they are pregnant/breastfeeding, any other medical conditions. Then we are required BY LAW (at least where I live) to run a drivers licence number through an internet system before handing out the cold and flu. I personally hate asking the questions and treating someone like a drug addict, but at least you're getting safe care. =)

Wow...now if only all states would do that so DR's and Pharmacies could look up something like that. I know working in a pharmacy would be a heck of a lot better if we could give them junkies some just desserts!!

your problems stem from the fact that the DEA and it's failed policies, practices, policing and prosecutions have an awful lot of MDs pissing in their pants at the mere thought of prescribing a controlled substance. And the criminal drug dealers with MDs, the Dr Feelgoods, don't help your cause much either.

@Anonymous re: pseudoephedrine. Do you know what impact the pseudo-regulation of pseudoephedrine has had on crystal meth production?Absolutely none. The cookers have just moved from batching large in residences to batching small in their cars.

Three cheers for the DEA, the most corrupt, detrimental and worthless of all federal law enforcement agencies!

want to sign up here for my pharmacy but I doubt I would have access to the system through the 'intranet' I just have to get the form notarized and sent in. My hubbys neuro has access and tells us theyll be checking before refils. Fine by us, he only gets his meds there. And not early.

I also have very mixed feelings on this one. I think its good in that it helps to catch those abusing the system but I also know a lot of people in the US who are in severe chronic pain due to a very painful condition that I also suffer from and they find it very difficult to get decent and appropriate pain treatment.

I think its also partially a cultural issue with a lot of fear, misinformation and outdated stereotypes.

I guess its a difficult issue. How to distinguish and prevent the abusers while also helping those in genuine need of decent pain relief. I don't envy you doctors having to navigate that minefield.

While I am very glad for you, and all the other docs that spend countless wasted hours (and dollars) seeing drug-seeking patients, I do chafe a little bit at the idea a doctor might form opinions about a person and/or decline to see me based on computerized (not always accurate, or complete) information. The system also adds yet another incentive (and headache for victims) for identity theft. Druggies, as stupid as they are, will find a way.

Louisiana maintains a similar registry, so doctors with state licenses (anyone who has taken and passed step 3, AKA not interns... but give me 'til this summer, I hope) can look up the controlled substances a patient has been prescribed. One of my patients had been to every hospital between Houma and Baton Rouge.

As a retail pharmacist, I personally like the monitoring program available in my state. However, it becomes frustrating when you "catch" someone who is abusing the system & as an Rph I can't just take away a legally written rx from someone. *I* can just refuse to fill it & try and get it, for lack of better terminology, revoked from the prescribing MD. Some of those MDs don't care. Patient get's mad, takes it back, goes down the street & gets it filled elsewhere. And where I am, I am NOT granted access easily. I had to fill out the app on my own (no biggie here) but I also have to check the system via my internet on my phone b/c the site is blocked on my work computers. Intentionally, probably not. but retail giants aren't as concerned about "seekers" & "abusers" as they are bottom lines. I, however, want my own cape & want it to make woosh noises!!

Dr. G, Our state has had this type of database for awhile now (available to all pharmacists and MDs) and is tremendously useful. Especially regarding those pts who gets narcs from one doc (and fill that rx on ins) and then get narcs from another doc and go to another pharmacy and pay cash. Busted.

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